To assess the effectiveness of contrast-enhanced mammography (CEM) recombinant images in detecting malignant lesions in patients with extremely dense breasts compared to the all-densities population.

Material and methods:
792 patients with 808 breast lesions, in whom the final decision on core-needle biopsy was made based on CEM, and who received the result of histopathological examination, were qualified for a single-centre, retrospective study. Patient electronic records and imaging examinations were reviewed to establish demographics, clinical and imaging findings, and histopathology results. The CEM images were reassessed and assigned to the appropriate American College of Radiology (ACR) density categories.

Extremely dense breasts were present in 86 (10.9%) patients. Histopathological examination confirmed the presence of malignant lesions in 52.6% of cases in the entire group of patients and 43% in the group of extremely dense breasts. CEM incorrectly classified the lesion as false negative in 16/425 (3.8%) cases for the whole group, and in 1/37 (2.7%) cases for extremely dense breasts. The sensitivity of CEM for the group of all patients was 96.2%, speci­ficity – 60%, positive predictive values (PPV) – 72.8%, and negative predictive values (NPV) – 93.5%. In the group of patients with extremely dense breasts, the sensitivity of the method was 97.3%, specificity – 59.2%, PPV – 64.3%, and NPV – 96.7%.

CEM is characterised by high sensitivity and NPV in detecting malignant lesions regardless of the type of breast density. In patients with extremely dense breasts, CEM could serve as a complementary or additional examination in the absence or low availability of MRI.

Bell RJ. Mammographic density and breast cancer screening. Climacteric 2020; 23: 460-465.
Sickles EA, D’Orsi CJ, Bassett LW, et al. ACR BI-RADS® Mammo­graphy. In: ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System. Reston, VA: American College of Radiology; 2013.
Boyd NF, Guo H, Martin LJ, et al. Mammographic density and the risk and detection of breast cancer. N Engl J Med 2007; 356: 227-236.
Lee CI, Chen LE, Elmore JG. Risk-based breast cancer screening. Med Clin North Am 2017; 101: 725-741.
Boyd NF, Martin LJ, Yaffe MJ, Minkin S. Mammographic density and breast cancer risk: current understanding and future prospects. Breast Cancer Res 2011; 13: 223. DOI: 10.1186/bcr2942.
Vinnicombe SJ. Breast density: why all the fuss? Clin Radiol 2018; 73: 334-357.
Mann RM, Athanasiou A, Baltzer PAT, et al. Breast cancer screening in women with extremely dense breasts recommendations of the European Society of Breast Imaging (EUSOBI). Eur Radiol 2022; 32: 4036-4045.
Horvat J V, Durando M, Milans S, et al. Apparent diffusion coefficient mapping using diffusion-weighted MRI: impact of background parenchymal enhancement, amount of fibroglandular tissue and menopausal status on breast cancer diagnosis. Eur Radiol 2018; 28: 2516-2524.
Mann RM, Cho N, Moy L. Breast MRI: state of the art. Radiology 2019; 292: 520-536.
Jochelson MS, Lobbes MBI. Contrast-enhanced mammography: state of the art. Radiology 2021; 299: 36-48.
Zhu X, Huang JM, Zhang K, et al. Diagnostic value of contrast-enhanced spectral mammography for screening breast cancer: systematic review and meta-analysis. Clin Breast Cancer 2018; 18: e985-e995. DOI: 10.1016/j.clbc.2018.06.003.
Hobbs MM, Taylor DB, Buzynski S, et al. Contrast-enhanced spectral mammography (CESM) and contrast enhanced MRI (CEMRI): Patient preferences and tolerance. J Med Imaging Radiat Oncol 2015; 59: 300-305.
Neeter LMFH, Robbe MMQ, van Nijnatten TJA, et al. Comparing the diagnostic performance of contrast-enhanced mammography and breast MRI: a systematic review and meta-analysis. J Cancer 2023; 14: 174-182.
Sudhir R, Sannapareddy K, Potlapalli A, et al. Diagnostic accuracy of contrast-enhanced digital mammography in breast cancer detection in comparison to tomosynthesis, synthetic 2D mammography and tomosynthesis combined with ultrasound in women with dense breast. Br J Radiol 2021; 94: 20201046. DOI: 10.1259/bjr.20201046.
Rudnicki W, Piegza T, Rozum-Liszewska N, et al. The effectiveness of contrast-enhanced spectral mammography and magnetic resonance imaging in dense breasts. Pol J Radiol 2021; 86: e159-e164. DOI: 10.5114/pjr.2021.104834.
Luczynska E, Piegza T, Szpor J, et al. Contrast-enhanced mammography (CEM) capability to distinguish molecular breast cancer subtypes. Biomedicines 2022; 10: 2384. DOI: 10.3390/biomedicines10102384.
Qin Y, Liu Y, Zhang X, et al. Contrast-enhanced spectral mammography: a potential exclusion diagnosis modality in dense breast patients. Cancer Med 2020; 9: 2653-2659.
Rajaram N, Mariapun S, Eriksson M, et al. Differences in mammographic density between Asian and Caucasian populations: a comparative analysis. Breast Cancer Res Treat 2017; 161: 353-362.
Goh Y, Chou C-P, Chan CW, et al. Impact of contrast-enhanced mammography in surgical management of breast cancers for women with dense breasts: a dual-center, multi-disciplinary study in Asia. Eur Radiol 2022; 32: 8226-8237.
Savaridas SL, Bristow GD, Cox J. Invasive lobular cancer of the breast: a pictorial essay of imaging findings on mammography, sonography, and magnetic resonance imaging. Can Assoc Radiol J 2016; 67: 263-276.
Badve SS, Gökmen-Polar Y. Ductal carcinoma in situ of breast: update 2019. Pathology 2019; 51: 563-569.
Solin LJ. Management of ductal carcinoma in situ (DCIS) of the breast: present approaches and future directions. Curr Oncol Rep 2019; 21: 33. DOI: 10.1007/s11912-019-0777-3.
Houben IP, Vanwetswinkel S, Kalia V, et al. Contrast-enhanced spectral mammography in the evaluation of breast suspicious calcifications: diagnostic accuracy and impact on surgical management. Acta Radiol 2019; 60: 1110-1117.
Cheung YC, Tsai HP, Lo YF, et al. Clinical utility of dual-energy contrast-enhanced spectral mammography for breast microcalcifications without associated mass: a preliminary analysis. Eur Radiol 2016; 26: 1082-1089.
Hasebe T, Imoto S, Sasaki S, et al. Proliferative activity and tumor angiogenesis is closely correlated to stromal cellularity of fibroadenoma: proposal fibroadenoma, cellular variant. Pathol Int 1999; 49: 435-443.
Dietzel M, Kaiser C, Baltzer PAT. Magnetic resonance imaging of intraductal papillomas: typical findings and differential diagnosis. J Comput Assist Tomogr 2015; 39: 176-184.
Gültekin MA, Yabul FÇ, Temur HO, et al. Papillary lesions of the breast: addition of DWI and TIRM sequences to routine breast MRI could help in differentiation benign from malignant. Curr Med Imaging 2022; 18: 962-969.
Baltzer P, Mann RM, Iima M, et al. Diffusion-weighted imaging of the breast-a consensus and mission statement from the EUSOBI International Breast Diffusion-Weighted Imaging working group. Eur Radiol 2020; 30: 1436-1450.
Clauser P, Krug B, Bickel H, et al. Diffusion-weighted imaging allows for downgrading MR BI-RADS 4 lesions in contrast-enhanced MRI of the breast to avoid unnecessary biopsy. Clin Cancer Res 2021; 27: 1941-1948.
Sorin V, Yagil Y, Shalmon A, et al. Background parenchymal enhancement at contrast-enhanced spectral mammography (CESM) as a Breast cancer risk factor. Acad Radiol 2020; 27: 1234-1240.
Savaridas SL, Taylor DB, Gunawardana D, et al. Could parenchymal enhancement on contrast-enhanced spectral mammography (CESM) represent a new breast cancer risk factor? Correlation with known radiology risk factors. Clin Radiol 2017; 72: 1085.e1-1085.e9. DOI: 10.1016/j.crad.2017.07.017.
Karimi Z, Phillips J, Slanetz P, et al. Factors associated with background parenchymal enhancement on contrast-enhanced mammography. AJR Am J Roentgenol 2021; 216: 340-348.
Luczynska E, Pawlak M, Piegza T, et al. Analysis of background parenchymal enhancement (BPE) on contrast enhanced spectral mammography compared with magnetic resonance imaging. Ginekol Pol 2021; 92: 92-97.
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